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Life-Sustaining Treatment Preferences: Matches and Mismatches Between Patients' Preferences and Clinicians' Perceptions
- Source :
- Journal of Pain and Symptom Management. 46:9-19
- Publication Year :
- 2013
- Publisher :
- Elsevier BV, 2013.
-
Abstract
- Better clinician understanding of patients' end-of-life treatment preferences has the potential for reducing unwanted treatment, decreasing health care costs, and improving end-of-life care.To investigate patient preferences for life-sustaining therapies, clinicians' accuracy in understanding those preferences, and predictors of patient preference and clinician error.This was an observational study of 196 male veterans with chronic obstructive pulmonary disease who participated in a randomized trial. Measures included patients' preferences for mechanical ventilation (MV) and cardiopulmonary resuscitation (CPR) if needed in their current state of health, and outpatient clinicians' beliefs about those preferences.Analyses were based on 54% of participants in the trial who had complete patient/clinician data on treatment preferences. Patients were more receptive to CPR than MV (76% vs. 61%; P0.001). Preferences for both treatments were significantly associated with the importance patients assigned to avoiding life-sustaining therapies during the final week of life (MV: b=-0.11, P0.001; CPR: b=-0.09, P=0.001). When responses were dichotomized (would/would not want treatment), clinicians' perceptions matched patient preferences in 75% of CPR cases and 61% of MV cases. Clinician errors increased as patients preferred less aggressive treatment (MV: b=-0.28, P0.001; CPR: b=-0.32, P0.001).Clinicians erred more often about patients' wishes when patients did not want treatment than when they wanted it. Treatment decisions based on clinicians' perceptions could result in costly and unwanted treatments. End-of-life care could benefit from increased clinician-patient discussion about end-of-life care, particularly if discussions included patient education about risks of treatment and allowed clinicians to form and maintain accurate impressions of patients' preferences.
- Subjects :
- Adult
Male
medicine.medical_specialty
Palliative care
medicine.medical_treatment
Context (language use)
Article
law.invention
Pulmonary Disease, Chronic Obstructive
Randomized controlled trial
law
Health care
medicine
Humans
Cardiopulmonary resuscitation
General Nursing
Aged
Veterans
Aged, 80 and over
Mechanical ventilation
Physician-Patient Relations
Terminal Care
business.industry
Communication
Patient Preference
Middle Aged
Respiration, Artificial
Cardiopulmonary Resuscitation
Hospice Care
Anesthesiology and Pain Medicine
Health Care Surveys
Physical therapy
Female
Observational study
Neurology (clinical)
Comprehension
business
Patient education
Subjects
Details
- ISSN :
- 08853924
- Volume :
- 46
- Database :
- OpenAIRE
- Journal :
- Journal of Pain and Symptom Management
- Accession number :
- edsair.doi.dedup.....327308196de549ae164e3648f3727b1d